Category Archives: Полезные статьи

READING MEDICINE ONLINE

All of us have googled their symptoms in search of quick answers. The Internet says we’re dying, while the doctor says it’s just a cold. Who is right? Reading medicine today is more accessible than ever. And whether it is dangerous or rather useful depends on the attitude of the reader.

Curious patients are a blessing. It is extremely enjoyable to work with a person who is interested in their health and wants to learn more. This helps with patient understanding and their active involvement in the therapy. We have several tips that will make your reading more successful:

1. EVERYONE CAN WRITE AN ARTICLE

Internet is accessible to all. You cannot know who is hiding behind a nickname or what their knowledge or intentions are. Be extremely cautious while reading and take everything with a grain of salt. This applies mostly to non-professional groups, forums and blogs.

Most health and care establishments have an official website with reliable and accessible information. We advise you to stick to them. Our articles are written by people who work in the medical field and are always double checked by a medical doctor. If you notice any inaccuracies, however, we kindly ask you to let us know.

2. LOST IN TRANSLATION

There are people who translate scientific papers with the best of intentions. The problem is that medical texts are challenging even for an experienced translator. It is very easy to make a mistake which completely changes the meaning of the text. If you speak a foreign language, we advise you to read the original text.

3. INTERNET WON’T REPLACE YOUR DOCTOR

Reading medicine online should not give you the confidence to self-treat, however easier it may be. If it was that simple, doctors would not study literally their whole lives. Each patient has individual needs and the choice of the most appropriate therapy is an art that is mastered by years of experience.

If you are interested in reproductive medicine, do not be afraid to ask us questions. We are also open to new ideas for articles that will be useful to you. You can always share your suggestions by sending us a Facebook message.

WHAT IS SPERM DNA FRAGMENTATION TEST AND WHICH PATIENTS IS IT FOR?

In our previous article, «Sexual Abstinence in Men and Pregnancy«, we mentioned that long abstinence in men is associated with an increase in spermatozoa with fragmented DNA. But what exactly does DNA fragmentation mean? Who is the test useful for?

Standard semen analysis gives information about the three main parameters,

evaluating male fertility (concentration, motility and morphology) but it does not give any information about the percentage of spermatozoa with DNA fragmentation. The integrity of sperm DNA can be disturbed as a result of exposure to chemicals, smoking, high temperature, free radicals, produced as a result of normal metabolism, and other factors. A high percentage of DNA fragmentation is associated with a lower fertilization rate, worse embryo quality and higher incidence of miscarriage.

Indications for sperm DNA fragmentation test

The test is usually recommended for men with normal parameters who together with their partner suffer from unexplained infertility and have undergone several unsuccessful IVF cycles or pregnancy losses.

The DNA fragmentation test could also be done for men with deviations in the main sperm parameters, provided that they have enough spermatozoa. Even though the cause of infertility is known in male factor patients, the DNA fragmentation test is done if the treating physician requests it. This usually happens again in the case of more than 3 unsuccessful IVF cycles or multiple pregnancy losses. Another reason is professional hazards such as chemical or heat exposure.

If an increased percentage of spermatozoa with fragmented DNA is found, lifestyle changes could be helpful. As well as avoiding the professional hazard, those include consuming antioxidant-rich foods and leading a generally healthy lifestyle without too much aerobic activity.

If you think the DNA fragmentation test may be useful in your case, discuss it with your treating physician.

Those of you who have been through IVF know that on the day of the procedure the male partner has to have between 2 and 5 days of sexual abstinence. The same is true if the man is going for semen analysis. What actually happens in the male body in those 2 to 5 days? Is there a connection between sexual abstinence in men and pregnancy rate?

Unlike ovulation in women, which is cyclical (usually once every 28 days), spermatogenesis is a constant process. Spermatozoa are stored in the epididymis and during ejaculation mix with secretions from the male accessory glands. These include mainly the prostate and seminal vesicles. It is logical to assume that the longer the period of sexual abstinence in a man, the more sperm will accumulate. However, the World Health Organization (WHO) reference values for sperm concentration, motility and morphology were determined for 2 to 5 days of abstinence. The reason is that this abstinence period is within physiological limits. Outside those limits the sperm accumulated in the epididymis could overflow and is flushed with urine.

There is some evidence that abstinence longer than the mentioned above could result in deterioration of sperm quality, in spite of the fact that semen volume and sperm concentration are usually higher. This deterioration is thought to be due to an increase in DNA fragmentation. It is hypothesized that when sperm are stored in the epididymis for long periods of time, they are exposed to free radicals, which increase the percentage of sperm with fragmented DNA. As the smallest cell in the human body with a very small amount of cytoplasm, the spermatozoon has limited mechanisms for neutralization of free radicals. Therefore, it is not recommended for spermatozoa to be left for a long time in the epididymis or once they are ejaculated.

According to a study published in 2017 in the prestigious American journal Fertility and Sterility, IVF cycles in which the male partner had less than 5 days of abstinence have on average higher pregnancy and live birth rates.

TESTS BEFORE IVF – WHAT YOU ARE TESTED FOR AND WHY?

Prior to every IVF cycle with own oocytes and sperm, there are certain tests which are mandatory for both partners. If you want to find out what you are tested for before IVF and what happens if one of the tests is positive, this article is for you.

The first type of tests that you have to go through are blood tests for HIV, Hepatitis B (HBV), Hepatitis C (HCV) and syphilis. Due to the fact that these are the most common serious transmissible (contagious) diseases, the European Union Tissues and Cells Directives as well as Bulgarian Law require every IVF patient to be tested for them. If one of the above mentioned tests is positive that does not necessarily mean that the IVF cycle will be canceled. According to Bulgarian legislation the cycle can continue if “the establishment has equipment and a validated procedure for processing and differential storage” of the contaminated biological material.

If a woman, negative for HBV, has a positive partner, his sperm can be used for fertilization, only after the “recipient woman has been vaccinated”.  If a woman, negative for HCV, has a positive partner, his sperm can be used for fertilization, only after the “recipient woman has given written informed consent”. If the male partner is positive for syphilis, his sperm can be used only after he ”has been cured”.

According to Bulgarian law in women positive for HBV or HCV, the IVF cycle can continue again provided that “the establishment has equipment and a validated procedure for processing and differential storage”. However, in women positive for HIV or syphilis, the cycle has to be canceled and the procured oocytes or zygotes disposed of.

Blood tests for HIV, HBV, HCV and syphilis have to be done NO EARLIER than 3 months before the procedure (ovarian follicular puncture).

As well as the blood tests both the female and male partner have to submit to microbiology testing of vaginal secretions and ejaculate, respectively. This test shows whether those secretions contain any microorganisms (e.g. bacteria and fungi) and what types. Depending on the type of microorganism(s) found antibiotic treatment before the procedure may be necessary. Microbiology testing of both partners has to be done NO EARLIER than 30 days before the procedure.

In the presence of certain risk factors (e.g. trips to countries with high incidence of malaria and others) additional blood tests may be required. For men chlamydia testing of a urine sample is also mandatory.

It is important to know that these tests are not done in order to find the cause of infertility. They are required by law in order to minimize the risk of contamination for the patients and the clinic staff during the IVF cycle.

Thalassemias are a group of hereditary blood disorders, characterized by the presence of abnormal forms of hemoglobin and reduced life of erythrocytes. Different forms of thalassemia vary in severity, and thus in their symptoms. The name of these diseases comes from the Greek word for sea «thalassa» because they are most common in the Mediterranean.

Hemoglobin is responsible for transporting oxygen and carbon dioxide by the erythrocytes. It is a protein made of 4 chains — 2 alpha and 2 beta. When you have thalassemia, the formation of these chains is affected to a varying degree.

WHAT FORMS OF THALASSEMIA EXIST?

Thalassemia is caused by a mutation in the genes responsible for the production of hemoglobin’s chains. One could have only one or several mutations which are passed from the parent onto their children. Depending on which genes are affected, there is alpha and beta thalassemia. There are also subtypes whose symptoms vary in severity.

WHAT ARE THE SYMPTOMS?

Usually they include fatigue, weakness, dark colored urine. The faces of the patients are often pale or yellowish due to the increased destruction of erythrocytes, and their abdomen may be swollen. Some forms of thalassemia occur immediately after birth, others around the 2nd year or later. In some people the symptoms are absent and they are only carriers of the mutation.

IS THERE TREATMENT?

Thalassemias are hereditary diseases, and there is no way to cure them completely. Your condition or that of your child can be maintained through nutritional supplements rich in iron or blood transfusions in the more severe cases. It is extremely important to monitor the level of iron in the blood because its overdose can be harmful.

TALASEMIA AND PREGNANCY

For women with thalassemia during pregnancy, anemia may get worse. Therefore, it is required to inform your obstetrician-gynecologist about your condition. It is also advisable to consult with a haematologist who will monitor your blood.

One of the greatest concerns of future parents is whether their child has a genetic disorder. The most severe form of thalassemia (Beta thalassemia major, Cooley’s anemia) can be diagnosed by prenatal genetic diagnosis and amniocentesis.

TYPES OF PRENATAL TESTS AND WHY WE NEED THEM

WHAT does THE SEMEN ANALYSIS TERM «Oligozoospermia» mean?

Dear friends,

We are certain that most of you know what semen analysis is and many have probably even had one themselves.  However, when you got the result of your semen analysis, did you understand them? If the answer is NO, then this article is for you.

The term «Oligozoospermia» is composed of the prefix «Oligo-» (from Greek — few), the word «zoo» (existing) and «spermia» (seed, semen). «Oligo-» refers to the number of spermatozoa in the ejaculate. The connecting word «zoo» in this case refers to the spermatozoa themselves, not the semen. «Spermia» is the only part that is always present in the conclusion of a semen analysis.

Thus, the term «Oligozoospermia» means that there is a reduced number of sperm in the whole ejaculate or a reduced concentration (number of sperm / ml of semen). The reduced number / concentration of sperm is determined by comparison with the reference values. New Life Clinic uses reference values ​​for concentration, motility and morphology that are in accordance with the 1999 World Health Organization Manual for the Processing of Human Sperm.
The reason is that the Center for Assisted Reproduction medical indications for financing of male factor infertility couples are also in line with this manual.

WHAT do «OligoASTHENOzoospermia» and «OligoTERATOzoospermia» mean? The reduced number / concentration of sperm is only one of the possible deviations. In addition, sperm motility could also be impaired. Motility deviations are marked by adding the prefix «astheno-«.Similarly, deviations from the reference interval for the third major parameter — morphology is marked by adding the prefix «terato-«. «Terato» comes from the ancient Greek word for «monster». Morphology is, generally speaking, the shape of the spermatozoon. Therefore, having а large number of «abnormal / monstrous» sperm is termed Teratozoospermia.
It is very important to understand that the result of a semen analysis is not a diagnosis. Sperm parameters vary between different samples of the same patient, sometimes considerably. They are affected by a variety of factors, including the number of days of abstinence, and are subject to improvement

Marijuana has been known to mankind for millennia. For the first time, it wasmentioned in manuscripts from Ancient China dating from 2373. BC. It was used both as a recreational drug and as a medicine. Marijuana is banned in many countries, including Bulgaria. In others, it is decriminalized in some form (for example, medical marijuana). Today, marijuana is more widespread than ever before, which makes us wonder if its use can affect fertility.

It is known that chronic use of marijuana can lead to addiction and, in the worst case scenario, to psychiatric problems. Precisely because it is forbidden in so many places, there are not many studies about its  connection to infertility, but experts believe that it may have an impact.

MARIJUANA AND MALE FERTILITY

The effects of marijuana on fertility are better studied in men. Regular use can reduce libido and lead to problems with erection and ejaculation. Semen analyses of these men also show abnormalities. They usually have a smaller number of sperm cells whose motility is also altered. Exposed to THC (tetrahydrocannabinol — the substance that makes you high), sperm initially show hypermotility (move very quickly). Consequently, their speed decreases and, as a result, they can hardly reach the egg.

WHAT ABOUT FEMALE FERTILITY?

In women, marijuana also reduces libido. Its frequent use is also associated with irregular ovulation. After smoking marijuana, THC is found in the female reproductive which affects sperm and thus the chances of fertilization to occur. The use of marijuana is also associated with an increased risk of miscarriage due to its effects on rapidly dividing cells such as the embryo’s cells. THC can indeed relieve the feeling of nausea, but its embryotoxicity makes it contraindicated in pregnant women.

THC can be found in the body for up to 8 days after a single marijuana use. Regular «consumers» need 2-3 months to clean marijuana from their bodies. If you plan to become pregnant, it is important to stop using marijuana. If you or someone you know has a problem with marijuana or other illegal substances, you can find help.

One of the conditions most commonly associated with weight gain and difficulty conceiving in women over the age of 30 is Hashimoto’s thyroiditis. That is not surprising given that 5 percent of the world’s population is or has been affected by the autoimmune condition, with over 80 percent of those being women.

WHAT IS HASHIMOTO’S THYROIDITIS?

In women with Hashimoto the immune system attacks the thyroid gland, which secretes the hormones Triiodothyronine (T3) and Thyroxine (T4). Due to structural and functional damage, over time the thyroid gland starts to secrete smaller amounts of T3 and T4. The medical term for this condition is «hypothyroidism» («hypo» — sub, low). The main function of both hormones is to regulate basal metabolic rate, heart rate and body temperature. When T3 and T4 levels are low, the metabolic and heart rates drop and body temperature decreases. This leads to a number of other symptoms, most notably constipation, fatigue and weight gain.

GETTING PREGNANT WITH HASHIMOTO

As we have discussed in previous articles, being overweight by itself makes conceiving more challenging because of the hormonal imbalance it causes. The increased amount of fatty tissue converts male sex hormones (androgens) into female sex hormones (estrogens). Often this is accompanied by insulin resistance (cells do not react to insulin), which in turn leads to elevated levels of insulin and androgens (male sex hormones). All of these factors have a negative effect on ovulation. It can become irregular or stop completely, which makes getting pregnant more difficult.

Even if they are not overweight, women with Hashimoto have a hormonal imbalance associated with decreased levels of T3 and T4. This can in itself lead to ovulation disorders and difficulty getting pregnant.

Even after getting pregnant, hormone levels in women with Hashimoto have to be monitored much more closely, because pregnancy has higher demands on the thyroid gland. If those are not met complications and even miscarriage can ensue. However, close monitoring of the pregnancy and good management of the autoimmune condition greatly improve chances of an uncomplicated pregnancy carried to term.

All this may sound alarming but remember that modern medicine offers very good management of Hashimoto’s thyroiditis. The most important thing is early diagnosis! In February 2018, the famous American supermodel Gigi Hadid announced on social media that she was diagnosed with the autoimmune disease. However, that did not stop her from becoming the 5^th highest paid model in 2017, with $ 9.5 million annual income.

Emotions and mood swings are something that almost every pregnant woman encounters at some point. This can be quite stressful especially for those of you who are more reserved and not used to expressing their emotions.

WHY ARE PREGNANT WOMEN MORE EMOTIONAL?

Many factors, both external and internal, affect emotionality during pregnancy. On the one hand, are estrogens and progesterone, whose levels are higher in pregnant women. They can also affect the mood of women in the different phases of the menstrual cycle. On the other hand, all the other factors — the joy of becoming a mother, worrying whether you will be financially stable after the baby is born or the fear of the birth itself. In some women even the change in appearance can be a source of stress and unpleasant emotions.

HOW CAN YOU HELP YOURSELF?

1. Accept that this is normal. All the emotions you feel are fully understandable and do not mean «there’s something wrong with you». If they do not prevent you from doing your daily activities, there is no cause for concern.
2. Be generous about your sleep. Good sleep can do miracles for physical and mental health. Some pregnant women, however, have trouble sleeping because of the size of the abdomen, difficulty breathing or heartburn. It is advisable to sleep sideways, and putting a pillow between the legs and under the abdomen relieves discomfort. If you suffer from heartburn, lift the upper part of the body with more pillows.
3. You are not annoying if you share. Surround yourself with the people who understand and support you and do not worry about telling them how you feel. If you prefer to share your thoughts with a stranger, do not be ashamed to look consult with a psychologist.
4. Mind your diet. When we do not feel well, we often resort to candy and junk food, a.k.a. comfort food. In fact, many of these foods are rich in salt, which can raise your blood pressure and make you hold fluid, which is unlikely to improve your mood.

Pregnancy comes with a lot of changes and everything happens so fast that makes adjustment difficult. Emotions, though sometimes inexplicable, are part of this great journey. They are not harmful, as long as we treat them in a healthy way.